| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,743 |
10,727 |
$536K |
| D0120 |
Periodic oral evaluation - established patient |
6,126 |
6,122 |
$425K |
| D1310 |
|
6,788 |
6,757 |
$305K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,583 |
3,581 |
$240K |
| D1206 |
Topical application of fluoride varnish |
10,418 |
10,406 |
$234K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,065 |
1,619 |
$200K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,256 |
3,034 |
$130K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,755 |
1,751 |
$122K |
| D1351 |
Sealant - per tooth |
2,610 |
903 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,587 |
7,640 |
$91K |
| D0272 |
Bitewings - two radiographic images |
6,029 |
6,018 |
$71K |
| D0603 |
|
4,021 |
4,010 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
472 |
367 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
871 |
558 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
861 |
557 |
$46K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
253 |
205 |
$25K |
| D0602 |
|
1,578 |
1,573 |
$23K |
| D9993 |
|
366 |
365 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
198 |
169 |
$15K |
| D9430 |
|
381 |
378 |
$12K |
| D0350 |
|
1,439 |
793 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
497 |
494 |
$6K |
| D0601 |
|
380 |
380 |
$6K |
| D0274 |
Bitewings - four radiographic images |
151 |
151 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
85 |
$1K |
| D2330 |
|
17 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$265.80 |